Wiadomości Lekarskie, VOLUME LXXIV, ISSUE 1, JANUARY 2021 © Aluna Publishing

REVIEW ARTICLE

ABORTION, HUMAN RIGHTS AND MEDICAL ADVANCES IN DIGITAL AGE 10.36740/WLek202101126

Yulia S. Razmetaeva, Olga O. Sydorenko DEPARTMENT OF THEORY AND PHILOSOPHY OF LAW, YAROSLAV MUDRYI NATIONAL LAW UNIVERSITY, KHARKIV, UKRAINE

ABSTRACT The aim: The article analyzes the impact of abortion on human rights and women’s health in the light of medical and technological advances of the digital age. Materials and methods: The methods of research were dialectic approach and general analysis of normative and scientific sources, analysis of the results of studies of women’s mental health after abortions, analysis of judicial practice, especially decisions of the European Court of Human Rights, the results of author’s own empirical studies, the formal legal method, the comparative legal method and the historical method. It has been established that there is no strong evidence that abortion negatively affects a woman’s mental health, including no evidence that the emotional consequences are deeply personal, or are rather the result of societal pressure. Arguments were refuted about extending the protection of human rights regarding abortion to unborn children and their fathers. Conclusions: The article emphasizes that the ethical burden on medical workers, especially in jurisdictions that require the approval of a doctor to legally terminate a pregnancy, increases significantly due to information flows and community expectations dictated by new medical advances. KEY WORDS: abortion, digital age, medical advances, human rights, reproductive health

Wiad Lek. 2021;74(1):132-136

INTRODUCTION determine who we consider to be the owner of rights, to Medical have traditionally received much attention, whom we give legal personality. including aspects such as ethical research and presenta- A separate issue is the gender aspect of abortion. Repro- tion of results [1], clinical research ethics [2], balance of ductive health is not a gender neutral issue. And the main patient interests and research consent [3], clash doctors burden, as well as social stigma, is imposed on women. In with ethically sensitive situations [4], the moral choice of addition, attempts to give the human rights to the fetus in doctors in sensitive matters and their right to participate the womb, and attempts to increase the rights of fathers, are or not to participate in certain medical practices, however, often associated with restrictions on the rights of women. in the digital age, all these issues become especially acute. The issues are becoming yet more significant because of both, increasing flows of disparate information that affect THE AIM all people in society, regardless of profession, and by new This article focuses on analyzing the impact of abortion advances at the intersection of and technology. on human rights and women’s health in the context of One of the ethically sensitive issues is abortion, which is the medical and technological advances in the digital age. also closely related to the discussion on human rights. First of all, it related with the right to life, which, of course, is fundamental, but at the same time is not an absolute right MATERIALS AND METHODS and may be limited in some cases. It must also be balanced The methods of research were dialectic approach and gen- with other rights, especially when it comes to abortion, with eral analysis of normative and scientific sources – to form the right to privacy, freedom of choice, human dignity and a complete picture of the relationship between sensitive is- bodily autonomy of women. An important and controver- sues, , women’s health and legal regulation in sial aspect is the moment of the beginning of life, since its the digital age, analysis of the results of studies of women’s legal and medical definitions may not coincide. The terms mental health after abortions – to verify the assumptions “viable fetus”, “premature baby”, “newborn”, “healthy baby” about personal emotional consequences and public per- are used in different contexts and do not always have legal ception, analysis of judicial practice, especially decisions of consequences. Moreover, for the implementation and pro- the European Court of Human Rights – to bring together tection of human rights it is extremely important to legally arguments about protecting and limiting of human rights,

132 ABORTION, HUMAN RIGHTS AND MEDICAL ADVANCES IN DIGITAL AGE including women’s rights and third party rights in terms of age, showed that rates of depression are not significantly abortion, as well as the results of our own empirical stud- different between women obtaining abortion and those ies – to test the perception of ethically sensitive situations denied abortion; and rates of anxiety are initially higher by lawyers and doctors, both practitioners and trainees. in women denied abortion care [8]. Limiting access to We also use a formal legal method – for studying legal abortion services does not have a positive effect on women documents, international treaties, human rights legislation and does not reduce the number of unwanted pregnancies. of the European Union and the United States of America; In particular, some researchers note that ensuring access a comparative legal method – to compare abortion laws to abortion services will not increase the likelihood that of different countries; a historical method – for tracking women will experience subsequent unintended pregnan- changes in societal attitudes towards abortion and its legal cies [9]. One of the latest sensational studies has shown regulation. that there is no evidence of emerging negative emotions or abortion decision regret; both positive and negative emotions declined over the first two years and plateaued REVIEW AND DISCUSSION thereafter, and decision rightness remained high and steady For many years, it was believed that an abortion done (predicted percent: 97.5% at baseline, 99.0% at five years); even during the early stages of pregnancy extremely at five years postabortion, relief remained the most com- negatively affects the health of women, both physically monly felt emotion among all women [10]. These results and mentally. At the same time, real female mortality rate were evaluated as evidence that emotions about abortion from complications after non-medical abortions and lack are related to the personal and, especially, social context, of access to legal termination of pregnancy remains quite rather than stemming from the abortion process itself. high, especially in countries where abortions are socially Thus, this is probably the attitude of society, and not real or legally condemned. In particular, unsafe abortion is the psychological problems that become the determining fac- leading cause of death among young women aged 10–24 tor in the negative emotional consequences of abortion for in sub-Saharan Africa [5]. women. Moreover, it was found that shortly after women Modern medicine in many cases makes it possible to get were denied an abortion, they experienced higher stress by with minimal intervention and minimal consequenc- than women who had an abortion [11]. This casts doubt on es for a woman’s physical health, therefore the focus of the benefits of prohibitions on abortion, even if we exclude studying negative abortion consequences has shifted to the argument about the right to personal choice of women. the woman’s mental health. However, there is no strong There are no studies that would reliably show how to evidence that abortion actually negatively affects women’s separate a woman’s truly personal internal emotions from mental health. Studies from a decade ago showed that those caused by social disapproval, so that one could there is a low or moderate risk of adverse mental health evaluate the real emotional consequences and formulate outcomes, such as psychological disorders and post-stress recommendations regarding abortion, and, furthermore, conditions. In particular, women who had undergone an argue that restricting access to abortion reduces emotional abortion experienced an 81% increased risk of mental harm. Moreover, in conservative and religious societies, health problems, and nearly 10% of the incidence of mental where this disapproval is much higher; the decision to health problems was shown to be attributable to abortion; terminate pregnancy is assessed as emotionally difficult women who had an abortion were more likely to report by women and as extremely wrong by others. As noted, adverse mental health outcomes compared with women assert that the rate of abortions and the easy acceptance who completed a pregnancy (OR 1.81, 95% CI 1.57 to 2.09) of abortion by a society is directly proportional with the [6], although the study noted that the likelihood of mental secularization degree of that society [12]. complications after an abortion is affected by the desire The spectrum of attitudes towards abortion in societies for pregnancy, combined with social factors that make it ranges from acceptance to complete intolerance, and impossible to continue, as well as conservative views on their legal provision ranges from a complete ban to full abortion. And this casts doubt on the fact that the negative legalization. In recent years, the movement for protecting effect stems from the fact of abortion itself, and not, for the right to life of the embryo (fetus) until birth has been example, from public condemnation of its fact. Another gaining strength. An attempt to extend the protection study found that abortion was associated with small to of personal rights to the fetus, which is actually located moderate increases in risks of anxiety (AOR 1.28, 95% inside another person, inside the woman’s body, leads to CI 0.97-1.70; p<0.08), alcohol misuse (AOR 2.34, 95% CI a direct legal prohibition or a significant complication of 1.05-5.21; p<0.05), illicit drug use/misuse (AOR 3.91, 95% the termination of pregnancy. This leads to absurd norms CI 1.13-13.55; p<0.05), and suicidal behavior (AOR 1.69, that extend the prohibition of abortion to violence. Ulti- 95% CI 1.12-2.54; p<0.01) [7], therefore, it was concluded mately, this threatens women’s rights and negatively affects that abortion may be associated with small to moderate the reproductive health system, forcing it to be guided by increases in risks of some mental health problems. non-medical considerations. However, recent studies disprove this. In particular, a Significant changes to abortion law in the United States 5-year study, the control group of which consisted of wom- of America (USA) occurred in 2019. Several USA states en who were refused abortion on the basis of gestational have adopted a number of rules that limit the possibility of

133 Yulia S. Razmetaeva, Olga O. Sydorenko having an abortion, for instance threatening doctors who The case “Paton v. United Kingdom”, in which a man perform abortions with huge jail terms. This does not take sought an injunction to prevent his wife from having an into account any reasons for the woman’s reluctance to abortion, showed that the issue of the rights of third parties continue pregnancy, such as conception as a result of rape could concern not only unborn children, but also their fa- or incest. This is a worrying trend towards tightening leg- thers. In this case, the husband tried to forbid his wife to have islation and government interference in the private sphere. an abortion, referring not only to the rights of the unborn It is doubly alarming if we recall that it is happening in a child, but also to the right of the father to make a decision as democratic and technologically developed country. At the part of the right to privacy [17]. However, as a result it was same time, over 40 European states permit abortion where established that the right to privacy cannot be interpreted “there is a risk to the woman’s health”, and there is “abortion so broadly as to extend to the father’s statements about his on demand” during the first trimester of pregnancy in over wife’s decision to terminate the pregnancy, forbid his wife thirty European states [13, p. 557]. to have an abortion or forbid the doctors to participate in it. The prohibition or restriction of abortion is often justi- Thus, the argument about human rights is refuted by the fied by protecting the rights of the unborn child. But the fact that the subject of such rights in terms of abortion is a problem is not only at what point the fetus begins to be woman, but not third parties, including unborn children considered a human, but also that such rights inevitably and their fathers. clash with the rights of a pregnant woman. For example, In the digital age, many sensitive issues are becoming in the case “Vo v. France” the European Court of Human more complex, including those related to medical ethics. Rights (ECtHR) affirmed that an unborn child is not con- On the one hand, unlimited opportunities open up, sidered a person whose rights are directly protected by such as using AI to advance the health of people, instant Article 2 of the European Convention on Human Rights exchange of experience of successful research and patient (ECHR) [14], that is, the right to life. The court established treatment strategies, processing of health-related data that the rights and interests of the mother, including her about various social groups, etc. In addition, other oppor- right to life, health and privacy, will have priority. At the tunities are greatly simplified, such as using information same time, ECtHR did not refute that an unborn child may technology to improve the situation with abortion infor- have a “right to life”, leaving this as a sensitive issue, at the mation: for instance, to collect faster and more accurate discretion of the state. information, such as in the studies mentioned above, or to In the case “A., B. and C. v. Ireland”, in which the appli- contact a public organization that provides safe abortion cants relied on Article 8 of the ECHR, that is, the right to kits and direct instructions for women around the world. privacy, challenging the law, which imposed restrictions On the other hand, some of the effects of digitalization on the prohibition of abortion in the Republic of Ireland, seem unpleasantly alarming, as if we were in a world of the ECtHR ruled that the right to privacy does not include dystopia. For example, the widely known case of Target, the right to abortion, although a woman’s right to respect in which the company’s analysts determined that the client for her private life should prevail over other rights and was pregnant and started sending thematic ads before she freedoms, including the rights of an unborn child [15]. shared this news with her family. Or numerous cases in In addition, the court emphasized that Ireland violated which AI, based on user behavior on social networks, deter- the ECHR because it did not provide an accessible and mined their interest in children’s products and continued to effective procedure by which a woman could establish display ads based on this, even if users hid it – for personal whether she has the right to legal abortion in accordance reasons, or because the pregnancy was interrupted, or in with applicable law. At the same time, the ECtHR noted the case of the appearance of a stillborn child. that there is no doubt about the severity and sensitivity The future of medicine in the digital era is associated with of moral and ethical problems arising in connection with individualization of treatment, including specific molecu- the issue of abortion, as well as the importance of relevant lar treatment methods for a particular patient, integrated public interests. Many researchers believe that the court medical specialties, extremely fast exchange of information should have expressed itself more specifically regarding between doctors [18], and, probably, universalized medical important issues of human rights and who is the subject databases. Improving human viability through technolog- of these rights. In particular, the issues such as the status of ical advances is likely to increase. It is currently approxi- the fetus under the right to life, and whether pregnancy has mately 23–24 weeks in developed countries, although the a “public aspect”, have been left undecided or ambiguous, extremely premature infant (less than 28 weeks gestation) while great emphasis has been placed on the “role of the and extremely low birth weight infant (ELBW) (< 1000 margin of appreciation in enabling states to strike their own grams) remain at high risk for death and disability with balance between the fetus and the pregnant woman” [13, 30–50% mortality [19]. And this creates a temptation for p. 556]. In addition, while the ECtHR attempts to portray opponents of abortion to extend the protection of human the margin as a means of respecting domestic morals and rights to any fetus that has reached a certain survival cultural values, “the margin of appreciation is applied as threshold (and to all earlier stages of pregnancy), to make a tool of evasion, yet these judicial politics amount to a the starting point of protection the heartbeat, the degree disproportionate response to the violation of women’s of fetal formation or the degree of survival of premature reproductive freedom” [16, p. 261]. babies outside the womb.

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135 Yulia S. Razmetaeva, Olga O. Sydorenko

ORCID and contributionship: Yulia S. Razmetaeva: 0000-0003-0277-0554 A,B,D,E,F Olga O. Sydorenko: 0000-0003-4121-9183 B,D,E,F

Conflict of interest: The Authors declare no conflict of interest

CORRESPONDING AUTHOR Yulia S. Razmetaeva Department of Theory and Philosophy of Law, Yaroslav Mudryi National Law University, Pushkinska 77, 61024, Kharkiv, Ukraine e-mail: [email protected]

Received: 04.03.2020 Accepted: 07.09.2020

A - Work concept and design, B – Data collection and analysis, C – Responsibility for statistical analysis, D – Writing the article, E – Critical review, F – Final approval of the article

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